上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (11): 1599-.doi: 10.3969/j.issn.1674-8115.2011.11.020

• 论著（临床研究） • 上一篇    下一篇

A型主动脉夹层主动脉根部受累的处理及疗效观察

李庆国, 王 强, 潘 俊, 武 忠, 周 庆, 王东进   

  1. 南京大学 医学院附属鼓楼医院心胸外科, 南京 210008
  • 出版日期:2011-11-28 发布日期:2011-11-29
  • 通讯作者: 王东进, 电子信箱: kaidj-0235062@hotmail.com。
  • 作者简介:李庆国（1974—）, 男, 主治医师, 博士；电子信箱: lqg0235062@163.com。
  • 基金资助:

    南京市医学科技发展项目（YKK09112）

Surgical management and outcomes of involved aortic root in type A aortic dissection

LI Qing-guo, WANG Qiang, PAN Jun, WU Zhong, ZHOU Qing, WANG Dong-jin   

  1. Department of Thoracic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Online:2011-11-28 Published:2011-11-29
  • Supported by:

    Nanjing Medical Science and Technology Development Program, YKK09112

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摘要：

目的 总结A型主动脉夹层主动脉根部处理的临床经验。方法 收集113例A型主动脉夹层患者的临床资料，其中97例主动脉根部受累，16例主动脉根部未受累。分别采用Bentall手术（46例）、主动脉窦部重建（48例）和Divid手术（3例）处理受累主动脉根部。对手术和随访情况进行回顾性分析。结果 患者院内死亡14例，99例治愈出院。随访结果显示：86例患者获得随访，随访时间6～108个月；接受Bentall手术的患者（26例）中1例死亡，接受主动脉窦部重建的患者（45例）中1例主动脉窦部有逐步扩大趋势并出现轻中度主动脉瓣关闭不全，接受David手术的患者（3例）中1例有轻中度主动脉瓣关闭不全。结论 A型主动脉夹层应根据具体病变处理主动脉根部，主动脉窦部重建保留了主动脉瓣而不需要长期抗凝，近中期效果良好。

关键词: A型主动脉夹层, 主动脉根部处理, 主动脉窦部重建

Abstract:

Objective To summarize the clinical experience in surgical management of aortic root in type A aortic dissection. Methods The clinical data of 113 patients with type A aortic dissection were collected, among whom aortic root was involved in 97, and aortic root was uninvolved in 16. Bentall procedure (n=46), reconstruction of Valsalva's sinus (n=48) and Divid procedure (n=3) were employed in the management of involved aortic root. The surgical outcomes and follow-up findings were retrospectively analysed. Results Fourteen patients died early after operation, and the other 99 patients were discharged. Eighty-six patients were followed up for 6 to 108 months. During the follow-up, one of the 26 patients undergoing Bentall procedure died, one of the 45 patients with reconstruction of Valsalva's sinus had gradually enlarged Valsalva's sinus and mild to moderate aortic insufficiency, and one of the 3 patients receiving Divid procedure experienced mild to moderate aortic insufficiency. Conclusion Surgical management of aortic root in type A aortic dissection should be performed according to the condition of aortic root. Reconstruction of Valsalva's sinus is a valvesparing technique with favorable early and intermediate outcomes.

Key words: type A aortic dissection, surgical treatment of aortic root, reconstruction of Valsalva´s sinus